Today, about 10 per cent of people living with HIV (PLHIV) in Australia are women, yet they continue to be relatively invisible in the HIV prevention message. As a heterosexual woman living with HIV for the past 21 years, I am acutely aware today that the experience of women living with HIV (WLHIV) is still mired in ignorance and invisibility.
Many in the general community and some health providers still think HIV is not an issue for women. I know of more than one woman whose GP said “oh you don’t need that” when she asked for a HIV test. Sadly some of these women were diagnosed with HIV as a result of their test.
Thankfully, Australia has maintained a strong HIV response for many in our community – gay men, men who have sex with men, sex workers and people who inject drugs. Yet based on new diagnoses of HIV, we have all the signs of a gradual “epidemiological shift.”
If we are serious about ending HIV, we need to start talking about the different ways HIV affects and impacts women. Unless we acknowledge this, we risk allowing ignorance, stigma and discrimination to gain the upper hand in the virtual elimination of HIV.
There are gender differences in HIV in Australia. Few women are diagnosed early with their HIV infection. When a woman is diagnosed with HIV, she usually finds out after years of living with HIV. By then her immune system has been significantly damaged. She has probably been admitted to hospital as a “late presenter” with an AIDS-defining illness. This woman will have missed out on the benefits of early diagnosis and any immediate advantage that anti-retroviral treatment (ART) could have given her. She will also experience more complications around her reproductive health which then impacts the health of her family and her own psychological health.
Women are less likely to test for HIV, compared to gay men and men who have sex with men. While well-meaning clinicians challenge women who pro-actively ask for HIV testing and tell them they don’t need to be tested, they continue to promote the misguided assumption that HIV is not an issue for women.
Young women and transgender women are conspicuously lacking in public health campaigns designed to educate the community about HIV. We must open up the conversation about HIV and women to reduce the invisibility of women living with HIV.
There are gaps in the HIV research data when it comes to understanding the impact of HIV specifically on the female body. This lack of information creates misunderstanding about the effects of ART for women, the impact of their hormonal differences and the HIV treatments side-effects on women. This doesn’t even begin to address the experience of women at the intersection of HIV and poverty, access to good medical care and treatment, rural and regional geography, and mental health factors – all aspects disregarded or overlooked.
The well-established culture of HIV testing within the gay community must be expanded to include women in our community to normalise the reality of HIV as a virus that impacts women as well as men. Recognising the impact of gender differences in HIV is a task for both men and women in the elimination of HIV today.